DANGERS AND COMPLICATIONS OF A

TOURNIQUET
PRESENTER- DR.RAMEEZ PATHAN

MODERATOR- DR.K.GHANASHYAM. KAMATH
PROFFESOR & UNIT CHIEF

DEPT OF ORTHOPAEDICS,
KMC-MANGALORE.




Incidence of major complication according to
middleton and varian(1974)
Overall- 1:8000
Upper limb- 1:5000
Lower limb- 1:13000

Flatt(1972)- major complications d/t faulty
equipment in upper limb sx- 2:1500

COMPLICATIONS OF
TOURNIQUET
Nerve injury
Post Tourniquet Syndrome(PTS)
Intra operative bleeding
Deep vein thrombosis
Skin blisters and necrosis
Digital necrosis
Toxic reactions
Compartment pressure syndrome
NERVE INJURY
Most common complication during U/L
Surgery
Radial N. is the most common nerve affected
Extent of injury ranges from mild transient
loss of function to permanent irreversible
damage
Doctor may be subjected for legal action from
the injured party
POST TOURNIQUET
SYNDROME
Immediate swelling of tissues following release
of tourniquet is d/t
Reactive hyperaemia
Increased capillary permeability
POST TOURNIQUET
SYNDROME
Brunner(1951) described it as
Puffiness of hand and finger
Stiffness of joints in hands
Colour change in hand
Subjective sensation of numbness without true
anaesthesia
Objective e/o weakness of muscles in hand &
forearm without real paralysis

PREVENTION OF POST TOURNIQUET
SYNDROME
Select the correct operative procedure acc. to pts
age & condition
Avoid wasting time by proper preop planing
Do not extend the tourniquet time unnecessarily
Elevate the limb after the operation
Encourage the patient to perform active movement
of pertinent part
INTRA OPERATIVE
BLEEDING
May be caused by-
Under pressurized cuff
Insufficient exsanguination
Improper cuff size
Loosely applied cuff
Excessive padding b/w cuff and limb

PRESSURE SORE AND
CHEMICAL BURNS
Skin damage due to shearing stress of the
tourniquet
Particular problem in older pt with delicate
skin
Pressure sores and skin blisters due to
pressure necrosis or shearing
Chemical burns may be by anti microbial
prep solution
DANGERS FROM USE OF
TOURNIQUET
Dangers from exsanguination
Dangers from the pressure in the tourniquet
cuff
Dangers from ischemia
Dangers from bleeding after closure of the
wound
Dangers from failing to remove the tourniquet


DANGERS FROM
EXSANGUINATION
Skin damage by tight esmarch bandage
Senility
RA
EDS
Subcutaneous nerve damage
Pulmonary embolism
Block of superficial femoral artery by
atheromatous plaque disruption
Cardiac overload if b/l exsanguination done
Elderly
Unfit pts
DANGERS FROM PRESSURE
IN TOURNIQUET CUFF
Damage to tissues like nerve, muscle and skin
Most likely to suffer permanent damage-
MUSCLE
Most severe functional disability from-
NERVE
Muscle damage effect- at local site of
compression
Nerve damage effect- distally into its distribution
area

TOURNIQUET PARALYSIS SYNDROME
Described by Moldaver-1954
Motor paralysis with hypotonia/atony but without
atrophy
Sensory dissociation
Touch, pressure, vibration, position- absent
Pain- hyperalgesia
Heat and cold- preseved
Skin colour & Temp- N as sympathetic- not affected
Peripheral pulse- N
DANGERS FROM
ISCHAEMIA
Tissue distal to cuff- anoxic, acidotic & loaded
with metabolites

Sickle cell disease- C/I
Sicke cell Trait- not absolute C/I but limb must
be exsanguinated thoroughly before cuff is
inflated
DANGERS FROM BLEEDING
AFTER CLOSURE OF THE WOUND
If tourniquet is released before wound closure-
Major source of Hrrage can be identified &
controlled
Tourniquet be released before nerve suture or a
skin graft applied- to ensure that haematoma
does not separate the tissues

Injury to popliteal A. during meniscectomy, which was not
recognised at the time of operation, has been reported (Pattrick,
1963)
DANGERS FROM FAILING TO
REMOVE THE TOURNIQUET

Six hours has been suggested as the dividing
line between removing the cuff & trying to
save the limb, and removing the limb above
the cuff to save the patients life.
( Klenerman,1962)
REFERENCES

Campbells operative orthopaedics- 11th edition
Traction and Orthopaedic Appliances- John Stewart
and Jeffrey Hallett 2nd edition
Current diagonosis & Treatment orthopaedics- Harry
Skinner- international edition
Greens operative hand surgery- 5
th
edition
Post graduate textbook of clinical orthopaedics-
Indian edition
Insall & scott- surgery of the knee- 4
th
edition



Surgical Tourniquets in Orthopaedics- Shahryar
Noordin, James A. McEwen et al- J Bone Joint Surg
Am.2009;91:2958-67

Tourniquet use and its complications in Norway-A.
Odinsson, V. Finsen J Bone Joint Surg [Br] 2006;88-
B:1090-2.




Thank you !